Encyclopedia of

Personality disorders

Definition

Personality disorders (PD) are a group of psychiatric conditions
characterized by experience and behavior patterns that cause serious
problems with respect to any two of the following: thinking, mood,
personal relations, and the control of impulses.

Description

Most personality disorders are associated with problems in personal
development and character which peak during
adolescence
and are then defined as personality disorders. Children and adolescents
with a personality disorder have great difficulty dealing with others.
They tend to be inflexible, rigid, with inadequate response to the changes
and demands of life. They have a narrow view of the world and find it hard
to participate in social activities. There are many formally identified
personality disorders, each with its own types of associated behaviors.
Most PDs, however, fall into three distinct categories or clusters,
namely: cluster A, which includes disorders characterized by odd or
eccentric behavior; cluster B, which includes disorders marked by
dramatic, emotional or erratic behavior; and cluster C, which includes
disorders accompanied by anxious and fearful behavior. The most common
disorders in each cluster are given below.

Cluster A disorders

These disorders include the following:

Schizoid personality disorder. Schizoid personalities are introverted,
withdrawn, solitary, emotionally cold, and distant. Often absorbed with
their own thoughts and feelings, they
fear
closeness and intimacy with others. People suffering from schizoid
personality tend to be more daydreamers than practical action takers,
often living "in a world of their own."

Paranoid personality disorder. Paranoid personalities interpret the
actions of others as deliberately threatening or demeaning. People with
paranoid personality disorder are untrusting, unforgiving, and often
resort to angry or aggressive outbursts without justification because
they see others as unfaithful, disloyal, or dishonest. Paranoid
personalities are often jealous, guarded, secretive, and scheming, and
may appear to be emotionally "cold" or excessively
serious.

Schizotypal personality disorder. Schizotypal personalities tend to have
odd or eccentric manners of speaking or dressing. They often have
strange, outlandish, or paranoid beliefs and thoughts. People with
schizotypal personality disorder have difficulties
bonding
with others and experience extreme
anxiety
in social situations. They tend to react inappropriately or not react
at all during a conversation, or they may talk to themselves. They also
have delusions characterized by "magical thinking," for
example, by saying that they can foretell the future or read other
people's minds.

Cluster B disorders

Cluster B disorders include the following:

Antisocial personality disorder
. Antisocial personalities typically ignore the normal rules of social
behavior. These individuals are impulsive, irresponsible, and callous.
They often have a history of violent and irresponsible behavior,
aggressive and even violent relationships. They have no respect for
other people and feel no remorse about the effects of their behavior on
others. Antisocial personalities are at high risk for substance abuse,
since it helps them to relieve tension, irritability, and boredom.

Borderline personality disorder. Borderline personalities are unstable
in interpersonal relationships, behavior,
mood, and self-image. They are prone to sudden and extreme mood
changes, stormy relationships, unpredictable and often self-destructive
behavior. These personalities have great difficulty with their own sense
of identity and often experience the world in extremes, viewing
experiences and others as either "black" or
"white." They often form intense personal attachments only
to quickly dissolve them over a perceived offense. Fears of
abandonment
and rejection often lead to an excessive dependency on others.
Self-mutilation
or suicidal threats may be used to get attention or manipulate others.
Impulsive actions, persistent feelings of boredom or emptiness, and
intense anger outbursts are other traits of this disorder.

Narcissistic personality disorder. Narcissistic personalities tend to
have an exaggerated sense of self-importance, and are absorbed by
fantasies of unlimited success. They also seek constant attention, and
are oversensitive to failure, often complaining about multiple physical
disorders. They also tend to be prone to extreme mood swings between
self-admiration and insecurity, and tend to exploit interpersonal
relationships.

Cluster C disorders

Cluster C disorders include the following:

Avoidant personality disorder. Avoidant personalities are often fearful
of rejection and unwilling to become involved with others. They are
characterized by excessive social discomfort,
shyness
, fear of criticism, and avoidance of social activities that involve
interpersonal contact. They are afraid of saying something considered
foolish by others and are deeply hurt by any disapproval from others.
They tend to have no close relationships outside the
family
circle and are upset at their inability to form meaningful
relationships.

Dependent personality disorder
. As the name implies, dependent personalities exhibit a pattern of
dependent and submissive behavior, relying on others to make decisions
for them. They fear rejection, need constant reassurance and advice, and
are oversensitive to criticism or disapproval. They feel uncomfortable
and helpless if they are alone and can be devastated when a close
relationship ends. Typically lacking in self-confidence, the dependent
personality rarely initiates projects or does things independently.

Compulsive personality disorder. Compulsive personalities are
conscientious, reliable, dependable, orderly, and methodical, but with
an inflexibility that often makes them incapable of adapting to changing
circumstances. They have such high standards of achievement that they
constantly strive for perfection. Never satisfied with their performance
or with that of others, they take on more and more responsibilities.
They also pay excessive attention to detail, which makes it very hard
for them to make decisions and complete tasks. When their feelings are
not under strict control, when events are unpredictable, or when they
must rely on others, compulsive personalities often feel a sense of
isolation and helplessness.

Demographics

In 2001 to 2002, fully 16.4 million Americans (7.9% of all adults) had
obsessive-compulsive personality disorder; 9.2 million (4.4%) had paranoid
personality disorder; 7.6 million (3.6%) had antisocial personality
disorder; 6.5 million (3.1%) had schizoid personality disorder; 4.9
million (2.4%) had avoidant personality disorder; and 1.0 million (0.5%)
had dependent personality disorder. According to the National Institutes
of Health, nearly 31 million Americans meet criteria for at least one
personality disorder. A 2004 survey showed that nearly 14.8 percent of
adult Americans met diagnostic criteria for personality disorders as
defined by the American Psychiatric Association's Diagnostic and
Statistical Manual of Mental Disorders. The risk of having avoidant,
dependent, and paranoid personality disorders is greater for females than
males, whereas risk of having antisocial personality disorder is greater
for males than females. There are no gender differences in the risk of
having compulsive or schizoid personality disorders. In general, other
risk factors contributing to the emergence of personality disorders
include being Native American or African American; being a young adult;
having a low socioeconomic status; and having any other status than
married.

Causes and symptoms

The exact cause of personality disorders is unknown. However, evidence
points to genetic and environmental factors such as a history of
personality disorders in the family. Some experts believe that traumatic
events occurring in early childhood exert a crucial influence upon
behavior later in life. Others propose that people are genetically
predisposed to personality disorders or that they have an underlying
biological disturbance (anatomical, electrical, or neurochemical).

Symptoms vary widely depending on the specific type of PD, but according
to the American Psychiatric Association, individuals with personality
disorders have most of the following symptoms in common:

self-centeredness that manifests itself through a
"me-first," self-preoccupied attitude

lack of individual accountability that results in a "victim
mentality" and blaming others for their problems

lack of empathy and caring

manipulative and exploitative behavior

unhappiness, suffering from depression, and other mood and anxiety
disorders

vulnerability to other mental disorders

distorted or superficial understanding of self and others'
perceptions that results in being unable to see how objectionable,
unacceptable, and disagreeable their behavior is

self-destructive behavior

socially maladaptive, changing the "rules of the game," or
otherwise influencing the external world to conform to their own needs

When to call the doctor

An appointment should be made with a healthcare provider or a mental
health professional if a child has persistent symptoms of a personality
disorder. Parents are often concerned about their child's emotional
health or behavior, but they do not know where to start to get help. The
mental health system can also be complicated and difficult for parents to
understand. When worried about their child's behavior, parents can
start by talking to the child's pediatrician or family physician
about their concerns. Personality disorders require treatment and parents
should try to find a mental health professional with advanced training and
experience with children, adolescents, and families. Parents should always
ask about the professional's training and experience. It is also
very important to find a good match between child, family, and the mental
health professional.

Diagnosis

The character of a person is shown through his or her personality, by the
way the person thinks, feels, and behaves. When the behavior is
inflexible, maladaptive, and antisocial, then that individual is diagnosed
with a personality disorder. Personality disorders are diagnosed following
a psychological evaluation that records the history and severity of the
symptoms. A personality disorder must fulfill several criteria. A deeply
ingrained, inflexible pattern of relating, perceiving, and thinking that
is serious enough to cause distress or impaired functioning defines a
personality disorder. Personality disorders are usually recognizable by
adolescence or earlier, continue throughout adulthood, and become less
obvious in middle age.

Treatment

There are many types of help available for the different personality
disorders. Treatment may include individual, group, or family
psychotherapy. Medications, prescribed by a patient's physician,
may also be helpful in relieving some of the symptoms of personality
disorders, such as problems with anxiety and delusions. Psychotherapy is a
form of treatment designed to help children and families understand and
resolve the problems due to PD and modify the inappropriate behavior. In
some cases a combination of medication with psychotherapy may be more
effective. PD psychotherapy focuses on helping patients see the
unconscious conflicts that are causing their disorder. It also helps them
become more flexible and is aimed at reducing the behavior patterns that
interfere with everyday living. In psychotherapy, patients have the
opportunity to learn to recognize the effects of their behavior on others.
The different types of psychotherapies available to children and
adolescents include the following:

.

Cognitive behavior therapy (CBT). CBT is focused on improving a
child's moods and behavior by examining confused or distorted
patterns of thinking. With CBT, the child learns that thoughts cause
feelings and moods that can influence behavior. For example, if a child
has problematic behavior patterns, the therapist seeks to identify the
underlying thinking that is causing them. The therapist then helps the
child replace this thinking with thoughts that result in more
appropriate feelings and behaviors.

Dialectical behavior therapy (DBT). DBT is used to treat older
adolescents with suicidal thoughts or who intentionally engage in
self-destructive behavior or who have borderline personality disorder.
DBT teaches how to take responsibility for one's problems and how
to deal with conflict and negative feelings. DBT often involves a
combination of group and individual sessions.

Family therapy
. This therapy approach is designed to help the family unit function in
more positive and constructive ways by exploring patterns of
communication and providing support and education. Family therapy
sessions can include the child or adolescent along with parents and
siblings.

Group therapy (GT). GT uses group dynamics and peer interactions to
increase understanding, communication, and improve social skills.

Play
therapy. This type of therapy is directed at helping younger children.
It involves the use of
toys
, blocks, dolls, puppets,
drawings
, and games to help the child recognize, identify, and verbalize
feelings. The psychotherapist observes how the child uses play
materials and identifies themes or patterns to understand the
child's problems. Through a combination of talk and play the
child has an opportunity to better understand conflicts, feelings, and
behavior.

Alternative treatment

Alternative treatments are available for personality disorders and most
are complementary to conventional psychotherapy. They include the
following:

Coloring therapy. CT uses the activity of coloring as a self-help
medium. While a person colors (with felt tipped markers, colored pens,
pencils, etc.) a state of consciousness similar to meditation occurs.
The approach is based on how people speak to themselves on the
"inside." During a coloring session, people are asked to
listen to the thoughts going on in their minds so as to become aware of
where their thoughts, feelings, and opinions come from.

Creative arts therapies. These therapies include art therapy,
dance/movement therapy, drama therapy, music therapy, poetry therapy,
and psychodrama. They use arts and creative processes to promote health,
communication, and expression; they encourage the integration of
physical, emotional, cognitive, and social functioning while enhancing
self-awareness and facilitating change.

Neurolinguistic programming. NLP is a method of examining the way a
person thinks and acts through language and using this knowledge to
effect change.

Nutritional concerns

The notion that foods and nutrients influence brain function and behavior
generated in the early 2000s widespread interest in the general public and
in the scientific community. However, the evaluation data are still
ambiguous when it comes to establishing a direct link between personality
disorders and diet, aside from recommending the avoidance of alcoholic and
stimulant beverages.

Prognosis

The PD outlook varies. Some personality disorders diminish during middle
age without any treatment, while others persist throughout life despite
treatment.

Prevention

The prevention of personality disorders is an area surrounded with
pessimism and controversy. Many mental health specialists believe that
these disorders are untreatable, that individuals with personality
disorder have little capacity for change; therefore not surprisingly, they
remain skeptical about prevention prospects. However, even though the
innate
temperament
of a person cannot be modified, understanding the factors that influence
the development of personality disorders (such as genetic risks and
environmental factors) may help prevention. Accordingly, some mental
health professionals advocate primary prevention steps, which should
include education of parents and primary healthcare workers, as well as
early psychotherapy and protection of traumatized children, which can be
carried out by child developing services. Some evidence suggests that
traditional doctor-patient relationships are of much less value than
programs which enable parents to see their own role as crucial and their
own actions as able to bring changes for the better in their
child's behavior. High quality parenting plays a critical role in
child development and, thus, in the prevention of personality disorders.

Parental concerns

Understanding personality disorders can be challenging for parents as well
as for children. During the last third of the twentieth century, great
advances were made in the areas of diagnosis and treatment of personality
disorders. Parents can help children understand that these are real
illnesses that can be treated. In order for parents to talk with a child
about a personality disorder, they must be knowledgeable of the subject.
Parents may have to do some homework to become better informed. They
should have a basic understanding and answers to questions such as what
are personality disorders, who gets them, what causes them, how are
diagnoses made, and what treatments are available. When explaining to a
child about how personality disorders affect a person, it may be helpful
to explain that feelings of anxiety, worry, and irritability are common
for most people. However, when these feelings get very intense, last for a
long period of time, and begin to interfere with school and relationships,
it may be a sign of a personality disorder that can, however, be treated.

A child's personality disorder often causes disruption to both the
parents' and the child's world. Parents may have difficulty
being objective. They may blame themselves or worry that others such as
teachers or family members will blame them. Recognizing these feelings and
seeking the help of professional care providers and support groups is the
best way to cope with this issue.

Medication can also be an effective part of the treatment for several
personality disorders in childhood and adolescence. A doctor's
recommendation to use
medication often raises many concerns and questions in both the parents
and the child. The physician who recommends medication should be
experienced in treating psychiatric illnesses in children and adolescents.
He or she should fully explain the reasons for medication use, what
benefits the medication should provide, as well as the possible negative
side-effects or dangers and other treatment alternatives.

KEY TERMS

Anxiety
—Worry or tension in response to real or imagined stress, danger,
or dreaded situations. Physical reactions, such as fast pulse, sweating,
trembling, fatigue, and weakness, may accompany anxiety.

Caring
—The demonstration of an awareness of and a concern for the good
of others.

Character
—An individual's set of emotional, cognitive, and
behavioral patterns learned and accumulated over time.

Delusion
—A belief that is resistant to reason or contrary to actual fact.
Common delusions include delusions of persecution, delusions about
one's importance (sometimes called delusions of grandeur), or
delusions of being controlled by others.

Eccentric
—Deviating from the center; conduct and behavior departing from
accepted norms and conventions.

Empathy
—A quality of the client-centered therapist, characterized by the
therapist s conveying appreciation and understanding of the
client's point of view.

Erratic
—Having no fixed course; behavior that deviates from common and
accepted opinions.